Provider Demographics
NPI:1982790044
Name:FANIZZA, YVONNE LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:LYNN
Last Name:FANIZZA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 FOXFIELD RD STE 320
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5731
Mailing Address - Country:US
Mailing Address - Phone:630-222-7375
Mailing Address - Fax:630-289-5871
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:SUITE 307
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-222-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health